Provider Demographics
NPI:1386740694
Name:STROKES FOR FOKLS THERAPEUTIC MASSAGE, LLC
Entity type:Organization
Organization Name:STROKES FOR FOKLS THERAPEUTIC MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STAUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:NCTMB, CMT
Authorized Official - Phone:651-423-4466
Mailing Address - Street 1:14555 S ROBERT TRL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-3130
Mailing Address - Country:US
Mailing Address - Phone:651-423-4466
Mailing Address - Fax:
Practice Address - Street 1:14555 S ROBERT TRL
Practice Address - Street 2:SUITE 102
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-3130
Practice Address - Country:US
Practice Address - Phone:651-423-4466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty